Data is vitally important to members of the profession of pharmacy and is essential in how we develop evidence-based methodologies that guide how we care for patients. Ensuring veracity of data is important in giving us the right foundation to develop long-term strategies to improve patient outcomes. That’s why it was particularly concerning to see the Trump administration issue new guidance on how COVID-19 data is reported.
Earlier this week, the Trump administration ordered hospitals to bypass the Centers for Disease Control and Prevention (CDC) and send all COVID-19 information to the Department of Health and Human Services (HHS). The new guidance requires hospitals to submit certain pieces of information on a daily basis. This data includes important information like daily reports on capacity and utilization, testing, and the availability of resources (e.g. hospital beds and ventilators). The administration says that this information “will be used to inform decisions at the federal level, such as allocation of supplies, treatments, and other resources.”
The Trump administration says that all public health agencies are on the same team, and that the new rule will help streamline data to assist public health officials in allocating resources. However, the decision to change data reporting has significant implications to the overall healthcare system and pharmacy in particular.
Changing Data Collection Makes It Harder To Make Decisions
Despite being months into a public health emergency that has claimed the lives of over 135,000, the national strategy of the federal government has been called into question. Decisions, such as how to safely reopen, are being left to the states. We’ve seen over the past few weeks that many states have struggled – many of them that opened up early are now imposing policies such as lock downs and mask mandates. Since these decisions are being made by local officials, it is important that local officials are able to access the data needed to guide these decisions. The major thing to note here is that local health officials did have access to CDC data. The new HHS database, however, is not open to the public, making it significantly harder for local officials to make important decisions. By taking this data away from the CDC, states and hospitals will not be able to frequently assess the impact of the virus on their communities and take the necessary steps to prepare. Bruce Meyer, president of Jefferson Health in Philadelphia, said the CDC’s data collection and analyses have been “highly reliable and efficient. Sidestepping these established tracking systems creates deep concerns that we will be unable to obtain appropriate and reliable information to perform research and manage our response to the virus.”
This Rule Adversely Impacts Rural Hospitals
Many state health leaders and hospital officials are ringing the alarms saying that this change will increase the burden on facilities that are already stretched thin by the pandemic. Smaller hospitals, in particular, are not well prepared to adopt new methods, especially given the fact that they have fewer resources. The COVID-19 pandemic has already threatened the ability for rural hospitals to remain financially viable. An analysis from Health Affairs shows that rural hospitals already operate on razor thin margins and rely on high margin services, such as elective surgeries, to keep them afloat. Since many of these hospitals have had to cancel these services, rural hospitals are in more danger than they’ve ever been. In order to keep overhead costs down, rural hospitals don’t have access to the same personnel resources to focus on data reporting. Changes in reporting requirements, especially the stipulation for daily reporting, will have severe implications on rural hospitals creating issues in medication distribution, health access, and patient-outcomes associated with COVID-19.
Allocation of Vital Resources Including Medication
By far the biggest impact this rule change will have in the short term is how the federal government distributes current and future COVID-19 treatments, such as remdesivir. The distribution of this critical medication had already been off to a rough start in May, with hospitals unsure about how doses were being distributed. Late last month, HHS put out a statement saying that they had reached a deal to distribute 500,000 additional doses of the medication. However, many state officials are now upset that changing data reporting during the middle of the allocation process could pose an unnecessary barrier in ensuring patients receive access to this life-saving medication. If hospitals, particularly rural hospitals, aren’t able to accurately report their data due to financial considerations, the lives of patients requiring medications could be in jeopardy. HHS Secretary Alex Azar has already said that data that hospitals report this week will be the basis by which the federal government distributes remdesivir and other therapeutic supplies.
What Data Needs to Change
Data is vital in ensuring that all stakeholders have access to the necessary information to make decisions. Beyond just that, it’s important that these stakeholders have access to the right information. We’ve seen cases over the past few months of state officials firing public health officials for refusing to manipulate data. This change in the flow of data by the Trump administration seems to be similarly motivated. However, that being said, there is still a need for specific types of data.
Over the past few weeks, we’ve seen more and more attention being placed on racial disparities in all areas of our society. Specifically as it relates to healthcare, we’ve seen minority communities face the overwhelming burden from the COVID-19 pandemic. In a past post we discussed how individuals that live in primarily minority populated neighborhoods have less access to COVID-19 testing. However, despite this awareness, there is still no comprehensive demographic data on people who are being tested or treated for the virus. It is critical that data be accessible in order to better understand how COVID-19 is affecting communities of color, and empowering local and state organizations to develop programs to respond to those communities.
Access to data to guide the decision making of our policymakers is vital. As members of the profession of pharmacy, we can see how interruptions in this access can result in gaps in patient care and financial consequences for our healthcare infrastructure, such as for rural hospitals. By advocating for increased access to this data across the healthcare continuum we can expect positive patient outcomes, more evidence-based decisions, and (hopefully) an end to this new normal.